Help! My breastfed baby won’t take a bottle

Breast fed babies do not need to learn to bottle feed. However there may be circumstances where for personal reasons, parents may prefer their infant to take a bottle here and there. This blog is for families who have made that choice but who are struggling to get their baby to accept a bottle.

I want you to know that bottle refusal in breastfed babies is very common and can be considered normal. A 2020 uk based study looking at 841 babies found that 61% of babies refused to take a bottle, despite strategies being trialled. Despite this being a normal phenomenon, over a quarter of mothers in this study felt that their baby’s bottle refusal negatively impacted their breastfeeding experience. This is why I produced my best selling online course - bottle refusal in breastfed babies.

When to start expressing and offering the bottle?

The world health organisation doesn’t recommend introduction of a bottle for a breastfeeding baby before 6 weeks of age. This is because it can interfere with establishing milk supply and babies can sometimes begin to show a preference for the bottle during these early days. If there is a need for supplemental feeding while you are establishing your supply or working with your baby to establish breastfeeding, there are other options as well as bottle feeding, these include finger feeding, cup feeding or using a supplemental nursing system. The lactation consultant who is supporting you will advise you on your options based on your individual circumstances.If you do introduce a bottle in these early days in order to supplement then it is important that you use the paced bottle feeding technique.

Why do some babies refuse a bottle?

Some breastfed babies just do not take to bottles and establishing bottle acceptance can be tricky, the strategies you may use will depend on the age of your baby. There are many differences between breast and bottle-feeding they include

• The mechanics. How your baby uses its muscles to drink and swallow

• Flow: The way the milk flows from a breast and bottle is different

• Function: At the breast the baby has multiple needs met such as comfort, sleep, nutrition and thirst. Bottle feeding is more typically solely for nutrition and the other needs are met in different ways. 

• The person: Mother vs other caregivers

As infants are creatures of habit it may take time and practice to learn to feed a different way and make a different association with sucking. Here are some tips that can help…

How do I start?

1. Choose one bottle and teat and stick with it: Don’t be tempted by the marketing, there is very little evidence to support claims that certain bottles are closer to breastfeeding. There is no need to buy loads and loads of bottles in case your baby prefers a certain shape! It’s more important that your baby has a consistent shape and flow as they are establishing bottle feeding.

2. Slow the flow: Go for a newborn or slower flow teat. This means that your baby is less likely to develop a preference for the faster flow of the bottle when they are feeding and reduces the risk that they may develop a bottle preference. Don’t worry about increasing the flow over time if your baby is happy on the slow flow. Babies who are breastfed don’t need to have faster flowing bottles as they grow.

3. Get the timing right: As I said before, don’t introduce a bottle too early. Wait until your supply is well established and your baby has the skills of latching and attaching down pat. This will give your baby the best chance of being able to learn to feed from both the breast and the bottle. When you start to offer the bottle to your baby, pick a time when they are not too hungry. Choose a time of day that your baby is happy and alert, and a little bit hungry, which will help motivate them to explore the bottle with their mouth and hopefully start to suck. Try to keep things consistent, especially at first, and offer your baby the bottle at the same time every day so they know what to expect.

4. Wait for the Gape: When you are offering the bottle, you want to help your baby to keep opening their mouth nice and wide, the way they do when they are latching on to the breast. To do this with the bottle, you can gently and slowly stroke the teat from their nose down to their chin to encourage them to open their mouth nice and wide. Follow their lead when they are exploring the teat, let them lick and play with the teat. If at first they try to push it out of the mouth with their tongue let them and then offer it again at their lips so they can open their mouth and latch on if they want. As your baby becomes more confident, they will take the bottle into their mouth and hopefully start to suck. When they make the association between the bottle and milk coming into their bellies, they will be happy to take the bottle.

5. Managing the milk: Start by using expressed breast milk as the taste will be familiar to them. If your baby doesn’t like the cold milk you are offering, you can try warming up the milk and the teat just slightly, so that it is more like the breast. But some babies may not like warmed milk, so in that case you can try them with colder milk and see if they prefer that temperature. It can also be helpful to dip the teat in the milk before the feed so that they make the association that the teat tastes of milk and may start sucking. 

6. Just enough: Remember when offering a bottle that your breast fed baby is used to regulating the amount they feed from you at each feed. This means they only take as much as they need. This self regulation can protect them against obesity when they are adults. When you are offering milk in the bottle you need to observe them closely for signs they have had enough, like pulling away, falling asleep or stopping sucking on the teat. When offering the bottle, your baby may only need to take small amounts of milk at a time.

What if those tips aren’t working?

1. If your baby is under 6 months, you could try using the ‘bait and switch’ technique. Start them feeding at the breast and then once they have had some milk try switching to the bottle whilst they are still in breastfeeding position. Sometimes this can work with younger babies until they have built the association between the bottle and their tummy being filled with milk.

2. If your baby refuses the bottle when they are awake and alert, you could try and associate the bottle with a time that the baby is feeling calm and slightly more sleepy. 

3. Have a consistent person offer the bottle: Sometimes people say to me that they are trying to have someone else give the bottle because Mum is associated with breastfeeding. While this works for some babies, your baby may associate mum with feeding times and therefore another person may not be successful at all. You will have to try and see how your baby responds to you and versus another feeder during the feed.

4. If your baby is over 6 months and you have been trying for a week or two and your baby is still refusing the bottle, I would suggest you stop trying and move on to an open cup. This is because babies lose the sucking reflex around 4-5 months, to make way for more complex feeding behaviours that they will need when they are ready to start solids at 6 months. If they don’t take the bottle after this time, you can try offering them milk in an open cup. Remember that cup drinking is a new skill and one that will need to be learnt. This includes amending the association of taking milk from something that is not the breast, which is also really strong. Offer a small amount at the same time each day while your child’s skills have time to develop. Remain calm, reassuring and patient which isn’t always easy.

5. If your child is older than 9 months, don’t even worry about trying the bottle just go straight to cup. You can try an open cup or a free flow straw cup such as Tum Tum Tots Tippy Up Cup. You can use STACEYZIMMELS at the checkout to get 10% discount.

6. I know lots of mums are returning to work at this time and are worried about how their baby will last all day without breastfeeding if they don’t take a bottle. I have lots more information about this in my blog, How to manage going back to work when you are breastfeeding.

If you read this blog and are still struggling then take a look at my online course - Bottle Refusal in Breastfed Babies for lots more advice, strategies and support, including how you manage feeding baby if they don’t take a bottle and you need to leave them.

Let me know if you have any other tips that have worked for you!